Provider Demographics
NPI:1134909344
Name:PHOENICIAN MEDICAL CENTER INC
Entity type:Organization
Organization Name:PHOENICIAN MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANUPAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-7447
Mailing Address - Street 1:1343 N ALMA SCHOOL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 S CASTLE DOME AVE STE D
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-5305
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty